Personally, I have little more to add to the myriad of comments made about these studies, aside from saying 'yes', both represent very detailed and potentially important areas of work. For people with autism and their families or caregivers however, I am inclined to suggest that such news from these studies is not going to be particularly useful in the day-to-day context.

Hence then why I've decided to focus instead on the paper by Adler and colleagues [3] in this post, and their rather less publicised work on "drug-refractory aggression, self-injurious behavior, and severe tantrums" in the context of autism.

To talk about aggression and autism has the ability to invoke emotion. On the one hand is the realisation that aggression can be part and parcel of the presentation of some autism, and both for the person themselves and their families, can have a profound effect on quality of life. As one example, I'll take you back to a post I did a while back on self-aggression, otherwise known as self-injurious behaviour (SIB), and autism and the extreme consequences it can sometimes have (see here).

On the other hand, there is the risk that talking about aggression with autism in mind may unfairly stereotype such behaviours to autism, all autism. In much the same way that the label schizophrenia carries with it some often over-emphasised links (see here) so one has to be mindful of the possible effects of talking about such behaviours and in particular, the over-generalisation that can accompany discussions. Just for the record, I'll bring the paper by Farmer and colleagues [4] to your attention and their conclusion: "children with autism spectrum disorder were reported to have less aggression and were more likely to be rated as reactive rather than proactive". Indeed, reactive or spontaneous aggression is also a theme when it comes to autism and the CJS too (see here).

That all being said, the Adler paper is an interesting one in terms of their assertion that from a total of 250 cases, 135 participants were diagnosed with an autism spectrum condition, and "53 of these individuals met drug-refractory symptom criteria" when it came to definitions of aggression and its relations. I should also add that drug refractory means resistant to change following the use of pharmacotherapy. Not wishing to dwell too much on the methodology employed by Adler et al - based on medical records and medication history charts - the authors set about looking for what characteristics may be correlated with drug-refractory aggression among their cohort. In the end, they determined a few important factors to be related: (a) a diagnosis of autism, (b) being over the age of 12 years, and (c) the presence of intellectual disability (or learning disability).

I hope you don't feel cheated by my highlighting what are three very general factors when it comes to aggression. Personally I feel that these represent important factors not least because the issue of intellectual disability in particular, does show more than a passing connection to challenging behaviours including those with an aggression element to them (see here). Indeed within that Moss paper [5] there are also a few other important points which may well be important; not least the association between things like depression and anxiety when it comes to the presentation of aggression and self-injury. One might even assume that this could be evidence for the presence of anxiety symptoms / disorders as being present where SIB is a feature of autism? Just sayin'.

The fact also that Adler and colleagues were looking at medication resistant aggressive behaviours in the first place is important. As they note: "We define drug-refractory aggression, self-injurious behavior, and severe tantrums in people with autism spectrum disorders as behavioral symptoms requiring medication adjustment despite previous trials of risperidone and aripiprazole or previous trials of three psychotropic drugs targeting the symptom cluster, one of which was risperidone or aripiprazole". In other words, such behaviours were not managed by something like risperidone or aripiprazole (which itself is having a bit of a hard time at the moment). This point in particular brings me back to some interesting work looking at the use of antipsychotics in other conditions and how one might extrapolate from other experiences to autism. In other words, before reaching for the antipsychotics, make reasonable efforts to see if there may be other reasons / causes for challenging behaviours like aggression. Certainly take some time to look at guidance like that produced by NICE (see here) and remember the weight gain issue [6] too.

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Questioning Answers

About Me

I have been involved in autism research for more years than I care to remember. My Questioning Answers blog (http://questioning-answers.blogspot.com/) is a place to describe and discuss various research into autism spectrum and related conditions. My Gutness Gracious Me blog (http://gutness-gracious-me.blogspot.com/) is for discussions on various gastrointestinal research. I make no recommendations, I am not giving any medical advice, I am not formulating any specific opinions and do not want to get into any ethical, political or religious debates. I am not trying to change anyone's opinions, views, beliefs or anything else. These are purely blogs about science and research in autism and a few other interesting things. Any posts I make are my own opinions and not reflective of any organisation I am affiliated to. Keep in mind that science deals with probabilities not absolutes.

ABOUT AUTISM SPECTRUM CONDITIONS

Autism or autism spectrum conditions describe several presentations characterised by core issues with social affect and stereotyped or repetitive actions. Diagnosis is made by observation and analysis of developmental history. These are heterogeneous conditions which can carry various co-morbidities and whilst described as life-long are affected by age and maturation. Autism means different things to different people. To some it means a need for life-long support. To others it is part of the varied tapestry of humanity. To all it means a need to foster a welcoming society with appropriate support and opportunities.